Mind-body interventions for treatment of phantom limb pain in persons with amputation.

Phantom limb pain (PLP) is a significant source of chronic pain in most persons with amputation at some time in their clinical course. Pharmacologic therapies for this condition are often only moderately effective and may produce unwanted adverse effects. There is growing empirical evidence of the therapeutic effectiveness of mind-body therapies for the relief of chronic pain; therefore, an exploration of their role in relieving amputation-related chronic pain is warranted. We undertook a focused literature review on mind-body interventions for patients with amputation who experience PLP. Because of study heterogeneity, only descriptive presentations of the studies are presented. Only studies of hypnosis, imagery, and biofeedback, including visual mirror feedback, were found; studies on meditation, yoga, and tai chi/qigong were missing from the literature. Few studies of specific mind-body therapies were dedicated to management of PLP, with the exception of mirror visual therapy. Overall, studies were largely exploratory and reflect considerable variability in the application of mind-body techniques, making definitive conclusions inadvisable. Nevertheless, the weight of existing findings indicates that a mind-body approach to PLP pain management is promising and that specific methods may offer either temporary or long-term relief, either alone or in combination with conventional therapies. The authors discuss the potential for usefulness of specific mind-body therapies and the relevance of their mechanisms of action to those of PLP, including targeting cortical reorganization, autonomic nervous system deregulation, stress management, coping ability, and quality-of-life. The authors recommend more and better quality research exploring the efficacy and mechanisms of action.

Sexual risk-taking among adult dating couples in the United States.

CONTEXT: Knowledge of sexual and contraceptive behaviors as risk factors for STDs is largely based on women's or men's separate reports of their attitudes and behaviors. Little research has been based on couples. METHODS: Data from the 2005-2006 National Couples Survey were used to examine the sexual risk-taking behavior of 335 dating couples. Associations between each partner's characteristics and the couple's probability of recently having had anal sex and of having done something to protect themselves from STDs were assessed using logistic regression analyses. Models included measures of power dynamics and partners' perceptions of who controls sexual and contraceptive decisions. RESULTS: Couples in which the female partner reported that her male partner made the decisions about sex and contraception had increased probability of having had anal sex during the four weeks prior to the interview. In addition, partners' relationship power and their perception of control over sex and contraception moderated associations between couples' behavior and partners' characteristics, experiences and beliefs. For example, although couples in which the male partners had known someone with AIDS were less likely than others to engage in anal sex, that association was much greater for males with high income-and thus greater power-than for those with low income. CONCLUSIONS: Sexual behaviors are not controlled by any one individual in a relationship; characteristics of each partner are important. Couples-based interventions that take into consideration relationship-especially power-dynamics may enable individuals to initiate and sustain safer-sex practices.

Sexual desire in later life.

The has been relatively little research on sexuality in later life, particularly among persons over 60 years of age. The existing literature consists of studies of small samples, much of it from a biomedical perspective. This literature suggests that age, hormone levels, specific illnesses, and various medications negatively affect sexual functioning in older persons. The study reports results from a survey of a large sample (N=1,384) of persons age 45 and older that included measures of a variety of biological, psychological and social factors that potentially influence sexual functioning. We report bivariate and multivariate analysis conducted separately for women and men. We find that the principal influences on strength of sexual desire among women are age, the importance of sex to the person, and education. In this sample of the population of older persons, attitudes are more significant influences on sexual desire than biomedical factors.

What are providers' reporting requirements for children who witness domestic violence?

Each year, 3.3 to 10 million children are exposed to domestic violence/abuse (DV). Providers' reporting obligations for these children are unclear. The child maltreatment statutes available on state's web sites (through August 2003) were reviewed. Only Alaska defines DV in the presence of a child as child abuse within its juvenile code. Within their child abuse definition and reporting statutes, many states include language such as "substantial risk" or "imminent danger" of "physical harm" or "mental injury." Although knowledge of the state law is an important first step, abiding by it may be challenging because most statutes are open to wide interpretation. As a result, providers are encouraged to seek advice from local child maltreatment specialists who understand the local legal interpretations and resources.

Intimate partner violence and job instability.

OBJECTIVE: Research has shown that intimate partner violence (IPV) affects the physical and mental health of victims. It can also compromise work performance, leading to job loss. We explored the potential link between job loss and IPV as part of a larger study on IPV and health care. METHODS: Thirty-two mothers in Midwestern IPV shelters or support groups were interviewed to gather information about their abuse histories, health care experiences, and demographic characteristics. Interviews were audio taped, transcribed, and reviewed for themes. RESULTS: Half of participants had lost jobs because of IPV. Reasons included: the abuser told the victim to quit, in order to be safe, excessive absences because of covering up the abuse, and health issues exacerbated by IPV. CONCLUSION: Job instability was common among IPV victims in this study. Although this study did not address cause and effect, evidence of job instability may be another "red flag symptom" indicating that providers should screen for IPV.